Migration of ventriculoperitoneal shunt into the rectum: A case report and literature review

Normal pressure hydrocephalus (NPH) is a reversible disease characterized by gait disorder, dementia, and urinary incontinence. Ventriculoperitoneal shunting (VPS) is the usual treatment, though rare complications like catheter migration can have serious implications. We report a 76-year-old male with NPH treated with VPS insertion using a programmable Medtronic Strata 2 valve. He had an initial good course but later developed anemia (Hb 4.3 g/dL) and rectal bleeding. Follow-up evaluation showed distal catheter migration, sigmoid colon perforation, and protrusion of the shunt through the rectum - a highly unusual complication. Surprisingly, he did not develop meningitis or peritonitis, perhaps because of localized inflammatory sealing. Initially, the patient was treated with antibiotics and blood transfusions before being admitted after observing the shunt in the anal canal. Imaging revealed colonic migration and necessitated immediate laparoscopic removal of the shunt and repair of the colon. Removal of the cranial end of the shunt was carried out by neurosurgery. He had a full recovery, resumed oral intake on day five, and was discharged with follow-up. Transanal VP shunt migration is a rare but serious complication, particularly in elderly or malnourished patients. Early recognition of gastrointestinal symptoms in shunted patients, such as rectal bleeding or anemia, is highlighted in this case. Suspicion is high, and immediate imaging is key. Counseling patients preoperatively about this rare complication should be stressed in high-risk patients.